UNIVERSITY  OF  CALIFORNIA 

MEDICAL  CENTER  LIBRARY 

SAN  FRANCISCO 


From  the  Library  of 
Oscar  E.  Eklund,  M.D. 


• 

m 


THE  KINETIC  DRIVE 

ITS  PHENOMENA  AND  CONTROL 


BY 

GEORGE  W.  C&ILE,  M.  D. 


PROFESSOR  OF   SURGERY,    WESTERN  RESERVE    UNIVERSITY  ;    VISITING  SURGEON 
TO   THE    LAKESIDE    HOSPITAL,    CLEVELAND 


Wesley  M.   Carpenter  Lecture 

before 
The. New  York  Academy  of  Medicine,  1915 

EDITED  BY 

AMY  F.   ROWLAND,  B.  S. 


ILLUSTRATED 


PHILADELPHIA    AND    LONDON 

W.    B.    SAUNDERS    COMPANY 

1916 


\ 


COPYRIGHT,  1916,  BY  W.  B.  SAUNDERS  COMPANY 


PRINTED    IN    AMERICA 

PRESS    OF 

W.     B.     SAUNDERS     COMPANY 
PHILADELPHIA 


/<?/£> 


TO 
ELISABETH 


93303 


PREFATORY  NOTE 


THIS  lecture  is  in  effect  an  epitome  of  a  monograph  in 
preparation  which  will  offer  the  complete  experimental 
evidence  upon  which  these  themes  and  postulates  are 
founded. 

In  that  volume  acknowledgment  will  be  made  of  the 
valuable  aid  given  by  all  who  have  collaborated  with  me 
throughout  these  researches,  and  in  the  bibliographic  lists 
published  therein  will  be  found  references  to  the  literature 
which  has  been  studied  in  this  connection. 

GEORGE  W.  CRILE. 

GUSHING  LABORATORY  OF  EXPERIMENTAL  MEDICINE, 
WESTERN  RESERVE  UNIVERSITY, 

CLEVELAND,  OHIO. 
May,  1916. 


TABLE  OF   CONTENTS 


PAGE 

I.    INTRODUCTION n 

II.    THE  KINETIC  MECHANISM u 

III.  FUNCTIONS  OF  THE  ADRENALS  AND  OF  THE  THYROID  IN  THE  KINETIC 

DRIVE 27 

IV.  CONTROL  OF  THE  KINETIC  DRIVE 35 

V.    THE  CHRONIC  KINETIC  DRIVE 54 

VI.    KINETIC  DISEASES 55 

Graves'  Disease 55 

Cardiovascular  Disease 62 

Bright's  Disease 64 

Diabetes 64 

VII.    SURGICAL  METHODS  OF  CONTROLLING  THE  KINETIC  DRIVE 65 

VHI.    SUMMARY 70 

7 


LIST  OF   ILLUSTRATIONS 


PAGE 

FIG.  i. — HISTOLOGIC  CHANGES  PRODUCED  IN  THE  BRAIN  BY  PHYSICAL  EXER- 
TION, INFECTION,  AND  SKATOL  (AUTO-INTOXICATION) 13 

FIG.    2. — HISTOLOGIC  CHANGES  PRODUCED  IN  THE  ADRENALS  BY  PHYSICAL 

EXERTION,  INFECTION,  AND  SKATOL  (AUTO-INTOXICATION) 15 

FIG.  3. — HISTOLOGIC  CHANGES  PRODUCED  IN  THE  LIVER  BY  EXTREME  PHYSI- 
CAL EXERTION,  INFECTION,  AND  SKATOL  (AUTO-INTOXICATION).  . .  17 

FIG.    4. — EFFECT  OF  PREGNANCY  ON  THE  BRAIN-CELLS  OF  A  CAT 19 

FIG.    5. — TRACING  SHOWING  EFFECT  OF  FEAR  ON  THE  ADRENAL  OUTPUT  OF 

A  CAT.     (CANNON  TEST) 21 

FIG.    6. — TRACING  SHOWING  THE  EFFECT  OF  DIPHTHERIA  TOXIN  ON  ADRENAL 

OUTPUT  OF  A  CAT.     (CANNON  TEST) 24 

FIG.    7. — TRACING  SHOWING  EFFECT  OF  SKATOL  ON  THE  ADRENAL  OUTPUT  OF 

A  DOG.     (CANNON  TEST) 25 

FIG.    8. — TRACING  SHOWING  EFFECT  OF  PREGNANCY  ON  THE  ADRENAL  OUTPUT 

OF  A  CAT.     (CANNON  TEST) 26 

FIG.  9. — COMPARATIVE  EFFECTS  OF  EXCISION  OF  THE  ADRENAL  GLANDS  AND 
OF  EXCESSIVE  ADMINISTRATION  OF  ADRENIN  ON  THE  BRAIN-CELLS 
OF  DOGS 29 

FIG.  10. — COMPARATIVE  EFFECTS  OF  EXCISION  OF  THE  THYROID  AND  EXCES- 
SIVE FEEDING  WITH  THYROID  EXTRACT  ON  THE  BRAIN-CELLS  OF 
DOGS 31 

FIG.  ii. — THE  EFFECTS  OF  EXTREME  ACTIVATION  ON  THE  BRAIN,  ADRENALS, 
AND  LIVER  OF  A  SOLDIER  WHO  HAD  SUFFERED  FROM  HUNGER, 
THIRST,  AND  Loss  OF  SLEEP;  HAD  MADE  THE  EXTRAORDINARY 
FORCED  MARCH  OF  180  MILES  FROM  MONS  TO  THE  MARNE;  IN 
THE  MlDST  OF  THAT  GREAT  BATTLE  WAS  WOUNDED  BY  THE  Ex- 
PLOSION  OF  A  SHELL;  LAY  FOR  HOURS  WAITING  FOR  HELP,  AND 
DIED  FROM  EXHAUSTION  SOON  AFTER  REACHING  THE  AMBULANCE  33 

FIG.  12. — TRACING  ILLUSTRATING  PROTECTIVE  EFFECT  OF  MORPHIN  IN  ANA- 

PHYLACTIC  SHOCK 37 

FIG.  13. — PROTECTIVE  EFFECT  OF  MORPHIN  AND  OF  NITROUS  OXID  ON  THE 
BRAIN-CELLS  OF  DOGS  WHICH  HAD  RECEIVED  INJECTIONS  OF 
DIPHTHERIA  TOXIN 39 

FIG.  14. — PROTECTIVE  EFFECT  OF  MORPHIN  AND  OF  NITROUS  Oxn>  ON  THE 
ADRENALS  OF  DOGS  WHICH  HAD  RECEIVED  INJECTIONS  OF  DIPH- 
THERIA TOXIN 41 

FIG.  15. — PROTECTIVE  EFFECT  OF  MORPHIN  AND  OF  NITROUS  OXID  ON  THE 
LIVERS  OF  DOGS  WHICH  HAD  RECEIVED  INJECTIONS  OF  DIPHTHERIA 
TOXIN 43 

FIG.  1 6. — THE  COMPARATIVE  EFFECTS  OF  AN  ACID  AND  OF  AN  ALKALI  ON  THE 

BRAIN-CELLS  OF  CATS 45 

FIG.  17. — THE  COMPARATIVE  EFFECTS  OF  AN  Aero  AND  OF  AN  ALKALI  ON  THE 

ADRENALS  OF  CATS 47 

FIG.  18. — THE  COMPARATIVE  EFFECTS  OF  AN  Aero  AND  OF  AN  ALKALI  ON  THE 

LiyERS  OF  CATS 49 

FIG.  19. — COMPARISON  BETWEEN  THE  EFFECTS  OF  SURGICAL  TRAUMA  ON  A 

NORMAL  DOG  AND  ON  A  DOG  WHOSE  CORD  HAD  BEEN  SEVERED  .  5 1 

FIG.  20. — SIMILARITY  BETWEEN  THE  FACIES  OF  ACUTE  AND  OF  CHRONIC  EMO- 
TIONAL ACTIVATION 57 

FIG.  21. — EFFECTS  OF  VARIOUS  FORMS  OF  CHRONIC  ACTIVATION  ON  THE  BRAIN- 
CELLS 59 

9 


THE   KINETIC   DRIVE 
Its  Phenomena  and  Its  Control 


I.    INTRODUCTION 

THE  species  of  animal  now  dominating  the  earth  more 
completely  than  any  other  is  at  this  moment  in  a  state  of 
abnormal  activity.  The  back-wash  of  the  European  War 
is  seen  in  the  quickened  pulse  everywhere,  even  in  this  land. 
Not  only  in  war  but  in  peace  also  the  complicated  machinery 
of  civilization  created  by  man  often  drives  him  to  his  own 
destruction.  Nowhere  is  this  industrial  and  commercial 
driving  more  intense  than  in  this  city.  It  has  occurred 
to  me,  therefore,  that  it  might  be  interesting  to  attempt  an 
analysis  of  the  mechanism  by  which  this  speeding  is  ac- 
complished, and  relate  it  to  the  speeding  which  is  due  to 
other  stimuli,  such  as  infections,  auto-intoxication,  physical 
injury,  etc.  Since  the  process  of  speeding  is  identical  with 
that  of  the  transformation  of  potential  into  kinetic  energy, 
the  state  of  increased  energy  transformation  might  fittingly 
be  called  the  kinetic  drive.  To  facilitate  discussion  I  shall 
assume  an  unwarranted  attitude  of  dogmatism  which  may 
be  evaluated  at  leisure. 

II.    THE  KINETIC  MECHANISM 

Man  is  a  mechanism — an  automaton — whose  primary 
work  is  the  transformation  of  energy  by  means  of  a  system 
of  organs  especially  adapted  to  this  end.  There  is  stored 
in  these  organs  during  sleep  the  energy  which  during  con- 


12  THE    KINETIC    DRIVE 


FIG.  i. — HISTOLOGIC  CHANGES  PRODUCED  IN  THE  BRAIN  BY  PHYSICAL  EXERTION, 
INFECTION,   AND   SKATOL.  (AUTO-INTOXICATION).     (From  photomicrographs 
X  310.) 
A,  Section  of  normal  cerebellum  of  a  cat.    B,  Section  of  cerebellum  of  a  cat 

which  had  been  subjected  to  extreme  and  prolonged  physical  exertion.     C,  Section 

of  cerebellum  of  a  cat  after  streptococcal  infection.     D,  Section  of  cerebellum  of  a 

cat  which  had  received  repeated  injections  of  skatol. 


FIG.  i. 


14  THE    KINETIC    DRIVE 


FIG.  2. — HISTOLOGIC  CHANGES  PRODUCED  IN  THE  ADRENALS  BY  PHYSICAL  EXER- 
TION, INFECTION,  AND  SKATOL  (AUTO-INTOXICATION).    .(From  photomicro- 
graphs X  1640.) 
A,  Section  of  normal  adrenal  of  a  cat.     B,  Section  of  adrenal  of  a  cat  which  had 

been  subjected  to  extreme  and  prolonged  physical  exertion.     C,  Section  of  adrenal 

of  a  cat  after  streptococcal  infection.    D,  Section  of  adrenal  of  a  cat  which  had 

received  repeated  injections  of  skatol. 


FIG.  2. 


1 6  THE    KINETIC   DRIVE 


FIG.  3. — HISTOLOGIC  CHANGES  PRODUCED  IN  THE  LIVER  BY  EXTREME  PHYSICAL 
EXERTION,  INFECTION,  AND  SKATOL  (  AUTO- INTOXICATION).     (From  photomi- 
crographs X  1640.) 
A,  Section  of  normal  liver  of  a  cat.    B,  Section  of  liver  of  a  cat  which  had  been 

subjected  to  extreme  and  prolonged  physical  exertion.     C,  Section  of  liver  of  a  cat 

after  streptococcal  infection.    D,  Section  of  liver  of  a  cat  which  had  received 

repeated  injections  of  skatol. 


THE   KINETIC    MECHANISM 


FIG.  3. 


THE    KINETIC    MECHANISM 


n  .D 

Section  of  normal  cerebellum  of  cat.  Section  of  cerebellum  of  pregnant  cat. 

FIG.  4. — EFFECT  OF  PREGNANCY  ON  THE  BRAIN-CELLS  OF  A  CAT.     (From  photo- 
micrographs X  310.) 

The  effect  of  the  long  activation  of  pregnancy  is  well  illustrated  by  the  generally 
disorganized  appearance  of  the  Purkinje  cells  in  B. 


21 


"c 

•s 

.a 

M 

.2 

5 

0 

-a 

o 

o 

•-; 

•4-> 

H 

1 

"i 

a 

0) 

c 

H 

8 

*j 

tc 

0    | 

s 

IH 

'3 

U 

_J 

•3 

"c 

CJ 

H 

0 

1 

'2 

1 

<! 

CJ 

o 

§ 

rf 

**« 

e 

j^ 

•p 

fci 
O 
H 
p 

roma 

V 

5 

a 

S 

1 

& 
t> 

O 

i 

_§ 

o 

3 

"2 

^ 

E 

i 

•^ 

~ 

- 

3 

"o 

J^ 

i 

Q 

i 

TJ 

"w 

M 

a 

H 

j 

§ 

M 

Ti 

3 

H 

G 

T"' 

Z 

•J 

M 

r- 

O 

M 

6 

."s 

(Q 
g 

.S 

H 

<-^j 

•d 

fl 

S 

O 

o 

'c 

S 

9 

n 

3 

§ 

-c 

U 

ING  EFFECT 

the  contractii 

n  the  normal 

f  increased  a 

later  stages 

B 

O 

o 

V 

O 

^ 

'P 

o> 

•5 

td 

t/3 

O' 

1 

1 

_0 

c 

3 

S 

3 

'> 

rt 

0 

9 

_E 

V 

"S 

A  '2  a  S 
— l  S  *•§  5 

.sill1 

iiS's 

•^     g     2     tn 

IfB    I 

m  .S  m 

J3     tn   TJ     >% 

H     4>     ^  -£ 

C     C     rt 

.9    o    <u 


THE   KINETIC   MECHANISM  23 

sciousness,  in  response  to  environmental  contacts  with 
distance,  contact,  or  chemical  ceptors,  is  transformed  into 
muscular  action,  into  heat,  or  into  the  representations  of 
muscular  action,  such  as  emotional  or  "mental  processes." 

The  impulse  or  driving  force  which  causes  the  trans- 
formation of  energy  within  the  organism  is  supplied  by 
certain  parts  of  the  brain,  and  in  the  brain  is  found  also  the 
mechanism  which  makes  the  final  manifestation  of  the  trans- 
formed energy  specific  to  the  environmental  contact  which 
initiated  the  driving. 

The  initiators  of  the  kinetic  drive  may  be  roughly  classed 
as  contact  ceptor  stimuli — physical  injury,  heat,  cold,  etc.; 
distance  ceptor  stimuli — written  and  spoken  language,  sight, 
smell,  etc.,  and  chemical  ceptor  stimuli — infection,  auto- 
intoxication, pregnancy,  excessive  food,  poisons,  etc. 
f  Whether  any  one  of  these  stimuli  acts  singly  or  in  combina- 
tion with  others,  the  end-effects  are  identical.  The  effects 
of  any  one,  therefore,  may  be  studied  as  typifying  all  the 
rest. 

The  organs  which  from  moment  to  moment  vary  and 

X  control,  accelerate  or  retard  the  driving  force  of  the  brain 

y^  are  the  adrenals;  the  pacemaker  of  the  kinetic  system  is  the 

*    thyroid;  and  the  final  act  of  adaptive  energy  transformation 

is  performed  by  the  muscles. 

The  primary  process  within  the  brain  by  means  of 
which  its  driving  force  is  created  and  sustained  is  oxida- 
tion. Oxygen  is  supplied  by  the  lungs.  If  the  blood  be 
acid,  oxygen  cannot  be  carried  by  the  hemoglobin.  Energy 
transformation  depends,  therefore,  upon  the  maintenance 
of  the  alkalinity  of  the  blood.  Since  the  transformation  of 
energy  in  the  body  is  always  accompanied  by  the  formation 
of  acid  by-products,  the  continuance  of  the  process  of 
energy  transformation  demands  a  mechanism  or  mechanisms 


24  THE   KINETIC   DRIVE 

by  means  of  which  the  acid  by-products  can  be  neutralized 
and  eliminated.  These  needs  are  met  mainly  by  the  liver, 
the  kidneys,  and  the  lungs.  The  acid  by-products  of  energy 
transformation  are,  to  a  large  extent,  broken  down  in  the 
liver  into  simple  compounds  which  are  harmless  to  the  kid- 
neys, by  which  these  soluble  end-products  are  eliminated; 
while  the  gaseous  end-products  are  eliminated  by  the  lungs. 


Rdded   Sec      f 
frfter    Injection  of   >• 
T?,phrher;q  IOAIO 


546. 


A  B  C 

FIG.  6. — TRACING  SHOWING  THE  EFFECT  OF  DIPHTHERIA  TOXIN  ON  ADRENAL 

OUTPUT  OF  A  CAT.     (Cannon  Test.) 

The  first  tracing  (A)  was  made  by  the  contractions  of  intestinal  muscle  beating 
in  blood  from  a  normal  cat.  These  contractions  were  inhibited  almost  entirely 
by  the  substitution  of  blood  from  the  same  cat  after  the  injection  of  diphtheria  toxin 
(B).  After  twenty  minutes  the  increased  adrenin  evidenced  by  B  was  oxidized  and 
the  intestinal  muscle  resumed  its  contractions  as  in  normal  blood. 


If  this  system  of  organs  which  we  postulate  is  primarily 
adapted  for  the  transformation  of  energy,  acts  as  a  unit,  and 
is  restored  only  during  sleep,  then  every  excessive  excitant 
of  muscular  action  or  of  heat  production  between  periods  of 
sleep — such  as  prolonged  consciousness  (insomnia),  muscular 
action,  emotion,  mental  exertion,  infection,  foreign  proteins, 
even  pregnancy,  etc. — should  cause  identical  changes  in  the 


THE   KINETIC   MECHANISM  25 

histologic  structure  and  the  function  of  each  organ  con- 
cerned in  the  transformation  of  energy  or  in  the  neutraliza- 
tion and  elimination  of  the  resultant  acid  by-products;  and, 
in  addition,  intense  and  short  as  well  as  long-continued 
activation  by  any  of  these  agents  should  cause  also  identical 


A  B 

FIG.  7. — TRACING  SHOWING  EFFECT  OF  SKATOL  ON  THE  ADRENAL  OUTPUT  OP  A 

DOG.    (Cannon  Test.) 

The  first  tracing  (A)  was  made  by  the  contractions  of  intestinal  muscle  in  blood 
from  a  normal  dog.  The  second  tracing  (B)  shows  the  partial  inhibition  of  the 
contractions  produced  by  the  substitution  of  blood  after  the  injection  of  skatol, 
evidencing  the  presence  in  the  blood  of  an  increased  amount  of  adrenin. 


acute  and  chronic  diseases.  In  other  words,  insomnia,  in- 
tense emotion,  extreme  exertion,  infection,  foreign  proteins, 
pregnancy,  etc.,  should  cause  histologic  changes  in  the  brain, 
the  adrenals,  and  the  liver  (Figs.  1-4) ;  an  increased  output 
of  adrenin  (Figs.  5-8);  hyperplasia  of  the  thyroid  and  a 


26 


THE    KINETIC    DRIVE 


change  in  its  iodin  content,  and  changes  in  the  glycogen 
content  of  the  muscles  and  of  the  liver. 

If  the  foregoing  be  true,  then  it  would  follow  that  each 
of  these  activators  would  cause  increased  acid  by-products. 
Therefore  exertion,  infection,  emotion,  mental  activity  (in- 
tensified consciousness),  foreign  proteins,  or  pregnancy 
should  produce  certain  identical  clinical  phenomena. 


FIG.  8. — TRACING  SHOWING  EFFECT  OF  PREGNANCY  ON  THE  ADRENAL  OUTPUT  OF  A 

CAT.     (Cannon  Test.) 

That  the  adrenal  glands  are  activated  during  pregnancy  is  demonstrated  by 
this  sharp  inhibition  of  the  contractions  of  intestinal  muscle  when  the  blood  of  a 
pregnant  cat  is  substituted  for  normal  blood. 

First  of  all,  we  know  that  each  of  these  activators 
causes  increased  respiration,  increase  in  the  frequency  and 
force  of  the  heart-beat,  thirst,  excitability,  perspiration, 
increased  acidity  of  the  urine,  and  identical  manifestations 
of  fatigue  and  exhaustion.  If  the  adrenals  determine  the 
driving  force  of  the  brain  from  moment  to  moment,  and  if 
each  activation  of  the  Kinetic  System  causes  an  increased 


FUNCTIONS  OF  THE  ADRENALS  AND  OF  THE  THYROID   27 

output  of  adrenin,  then  it  would  follow  that  adrenin  alone 
would  produce  the  basic  phenomena  caused  by  any  excitant 
of  energy  transformation — such  as  exertion,  injury,  infection, 
emotion,  pregnancy,  etc. — and  would  produce  identical  histo- 
logic  lesions;  and  it  does.  In  addition,  adrenin  given  over  a 
long  period  of  time  causes  myocarditis,  glycosuria,  albumin- 
uria,  fatigue,  and,  in  addition,  many  symptoms  of  cardio- 
vascular disease  and  of  cardiorenal  disease. 

HI.    FUNCTIONS   OF   THE   ADRENALS   AND  OF  THE  THYROID 
IN  THE   KINETIC   DRIVE 

If  adrenin  causes  phenomena  identical  with  those  pro- 
duced by  emotion,  exertion,  infection,  etc.,  and  if,  vice  versa, 
emotion,  infection,  exertion,  etc.,  each  causes  an  increased 
output  of  adrenin,  then  we  may  infer  that  it  is  through  the 
increased  mobilization  of  adrenin  that  increased  energy 
transformation  is  accomplished  by  each  of  these  activators. 
Again,  if  this  be  the  role  of  adrenin,  we  should  find  that  in 
a  state  of  adrenal  deficiency  the  manifestation  of  energy 
transformation  would  be  diminished.  And  we  find  that 
this^is  true,  for,  after  double  adrenalectomy,  there  is  a  de- 
creasing and  finally  a  total  loss  of  muscular  power  and  of 
heat  production  (Fig.  9). 

If  the  nerve-supply  of  the  adrenals  be  divided  and  then 
an  adequate  adrenal  stimulus  applied,  the  output  of  ad- 
renin is  not  increased.  If  the  nerves  are  intact,  and  a  large 
dose  of  morphin  be  previously  given,  the  application  of  an 
adequate  adrenal  stimulus  causes  no  increased  output  of 
adrenin. 

We  therefore  conclude  that  the  brain  controls  the  trans- 
formation of  energy  by  first  driving  the  adrenals,  thus  mobil- 
izing adrenin  which  is  carried  to  the  brain  in  the  blood- 
stream. The  result  of  the  chemical  combination  of  oxygen, 


28  THE    KINETIC    DRIVE 

adrenin,  and  brain-cell  substance  appears  to  be  the  pro- 
duction of  energy  impulses,  these  impulses  being  probably 
identical  with  electricity  (Crehore  and  Williams).  The 
electromotive  force  thus  supposed  to  be  fabricated  in  the 
brain  is  transmitted  to  the  muscles,  where  the  energy  is 
finally  transformed  into  heat,  running,  fighting,  etc.  Since 
the  adrenals  hold  but  a  limited  supply  of  adrenin,  one  would 
expect  to  find  in  the  body  some  organ  whose  function  is  the 
secretion  in  abundant  quantity  of  a  substance  by  which  the 
efficiency  of  adrenin  is  increased.  The  belief  that  this 
function  is  performed  by  thyroid  secretion  is  strengthened 
by  the  researches  of  Osterhaut,  who  found  that  iodin  causes 
an  increased  permeability  of  living  vegetable  tissue  to  the 
passage  of  electricity.  The  activity  of  thyroid  secretion  is 
directly  proportional  to  the  amount  of  iodin  it  contains,  and 
we  know  that  excessive  doses  of  iodin  alone  cause  all  the 
phenomena  of  emotion,  exertion;  and  inversely,  that  emotion, 
infection,  exertion,  etc.,  cause  changes  in  the  iodin  content 
of  the  thyroid  (Fig.  10).  If  in  the  midst  of  iodism  double 
adrenalectomy  be  performed,  the  phenomena  of  iodism 
should  be  diminished, 

In  this  interrelation  of  the  brain,  the  thyroid,  and  the 
adrenals  we  have  what  perhaps  is  the  master  key  to  the 
automatic  action  of  the  body;  that  is,  through  the  special 
senses  environmental  stimuli  reach  the  brain  and  cause  it  to 
liberate  energy,  which  in  turn  directly  or  indirectly  activates 
certain  other  organs  and  tissues,  among  which  are  the  thyroid 
and  the  adrenals.  The  increased  output  of  thyreoiodin,  by 
facilitating  the  transmission  of  electric  currents  through  semi- 
permeable  membranes,  increases  the  passage  of  nerve-impulses 
and  sets  the  pace  for  energy  conversion.  In  consequence,  the 
adrenals  are  driven  to  increased  activity,  and  the  increased 
adrenin  in  turn  excites  the  brain  to  still  greater  activity,  the 


FUNCTIONS  OF  THE  ADRENALS  AND  OF  THE  THYROID   2g 


">/> 

MT 


a*  vr>;r* v. j-  > 

>  ^f- ;» *  v  .  •  - '/;  v *  Lij    ^^4"-: 

3t^*  *yrv  ^4S^o? 

B^5^SPW?« 


.s 

a 
1 

"rt 

•n 

V 

'Z 

g 

2 

43 

4 

! 

a 

«NON 

*-> 

cd 

S 

.y 

•| 
o 

8 

D 

1 

3 

73 

S3  .S 

M 

M 

"rt 

rt 

"S 

73 

*j 

Cj      Lri 

Q 

H 

*o 

. 

•  FH 

rt 

M*0 

2 

i) 

M 

LH 

o    a 
•a  "g 

o 

-a 

u 

•g 

•  -H 

i 

0-3  g 

g 

*c5 

0 

g 

rt 

73 

il 

o 

w 

o 

^ 

(U 

^ 

'2 

3    O 

p 

_o 

1° 

a 

S  '" 

2 

s 

t/2 

w 

<u 

:- 

O 

(/i 

"f/3 

rn 

0) 

Q 

i 

c 

"S 

•5 

rt 

o 

•rj 

flj 

0 

§ 

1 

i 

XCESSIVE  ADM: 

6 

M 

CO 

X 

! 

;  in  B  in  the  ext 

ration  of  some  < 

^ 

u 

_0 

§ 

o 
4= 

Oa 

.  These  effect 

j  excessive  dos< 

H 

O 

y 

t! 

c 

r^ 

VJ 

1 

§ 

2 

| 

a 

3J 

to 

IP 

0 

A 

1 

o 

1 

o, 

Q, 
cj 

73 

1 

^-) 

1 

"O 

Q 

3 

B 

m  of  dog  after  a 

NAL  GLANDS 

"o 

•a 

2 

etic  system  is 

[most  comple 

adrenin  is  s 

tegration  in  i 

on  or  by  adn 

tion  of  cerebellu 

DF  THE  ADRE 

to 

1 

h 

o 

cfl 

from  the  kin 

•a 

-C 

9 

inistration  of 

ion  and  disin 

1 

73 

I 

^  1-1 

o   w 

t-H        O 


'c  g  -9 

a^  d 


ctf     d 
bO    O 

II 

S      <L> 


."S      m 

&  73 


Er    n    K 

•s  ^  i 

H  £  *3 


*-z  a 

a.^^ 
1^1 

&  s  & 

"d  ^ 


152  3 


u. 

O     1) 


FUNCTIONS    OF    THE    ADRENALS    AND    OF    THE    THYROID      31 


•  .  .»  '     r 

*  —^  A    —          JT" 

^^^ 


A    — 


8  .2 


i.'2    X 
2  W 


£P  o 
_S    s 


J3 


O    J3 

— 

V 

O 

c 

—  ' 

_3  •£ 
£ 

V    tt> 

THYRO: 

u 

0 

(5, 

8 

ct 

"o 

^ 

a> 
1 

fe  .S 

U    -0 

d 

CO 

EEDING  WITH 

d 
X 

i 
.S 

.  The  effect 

erated  cells. 

the  cells  in  A 

c 

c 

1 

H 

E 

t 
2 

o 

•a 

"o 
6 

tc 
u 

— 

o 

99 

V 

'3 

•« 

«0 

q 

>, 

•^ 

>> 

S 

B 

u 

i 

a 

j£ 

3 
O 

t! 

X 

1 

.2 

d 

T3 
0 

i 

< 

"c 

5 
» 

o 

1 

c 

grt 

'•i 

o 

El 

1 

•a    . 
'o  E 
S3 

YROID 

.2 

^= 

Ui      <L> 

p 

C      0 

_>, 

5 

S 

S  S 

O 

!2 

:/) 

13 

1 

H 

^ 

•o 

d 

"2 

Bfl 

CO 

« 

o 

5 

^ 

i 

c 

1 

SIGN  OF  TH 

1 
g 

•oid  secretii 

u 

a 

S 

p 

"S 

roid  secret: 

_>> 

1 
'3 

I 

I 

5, 

5 
?f 

eg 

[rt 

fi 

•S 

form  si 

O 

2 

C 

3 

> 

's 

•t 

H 

n 

§ 

i 

i 

Ig 

^ 

-r 

.« 

-c 

-5 

E 

H 
h 
W 

*8 

"rt 
§ 

u 
a> 

3 
1 

u 

H 

to 

"tJ 

*s 

1 

E 
0 

13 

^ 

fc 

H 

o 

S 

< 

o 

8 

^ 

"2 

o 

^ 

•^ 

pS 

<u 
'> 

ion  of  n 

0 

U 

§ 

4) 

1 

fa 

a  marl 

Tj 

d 

o 

'TJ 

5* 

,4J 

en 

M 

-E 

5 

V 

c 

0 

H 

•8 

d 

THE    KINETIC    DRIVE 


FIG.  ii. — THE  EFFECTS  OF  EXTREME  ACTIVATION  ON  THE  BRAIN,  ADRENALS,  AND 

LIVER  OF  A  SOLDIER  WHO  HAD  SUFFERED  FROM  HUNGER,  THTRST,  AND  Loss  OF 

SLEEP;  HAD  MADE  THE  EXTRAORDINARY  FORCED  MARCH  OF  180  MILES  FROM 

MONS  TO  THE  MARNE;  Ix  THE  MIDST  OF  THAT  GREAT  BATTLE  WAS  WOUNDED  BY 

THE  EXPLOSION  OF  A  SHELL;  LAY  FOR  HOURS  WAITING  FOR  HELP,  AND  DIED 

FROM  EXHAUSTION  SOON  AFTER  REACHING  THE  AMBULANCE.    (A  and  D  from 

photomicrographs  X  310;  B,  C,  E,  and  F  from  photomicrographs  X  1640.) 

A,  Section  of  normal  cerebellum;  B,  section  of  normal  adrenal;  C,  section  of 

normal  liver;  D,  section  of  cerebellum  of  soldier  described  above;  E,  section  of 

adrenal  of  soldier  described  above:  F,  section  of  liver  of  soldier  described  above. 


FIG.   ii. 


CONTROL    OF    THE    KINETIC    DRIVE  35 

results  of  which  are  equivalent  to  increased  work  of  the  sym- 
pathetic nervous  system.  These  results  are  principally  the 
following — increased  heart-beat,  increased  respiration,  raised 
blood-pressure,  increased  sweating,  thirst,  the  transfer  of 
much  of  the  blood  from  the  splanchnic  area  to  the  surface, 
increased  output  of  glycogen,  increased  power  of  the  muscles 
to  metabolize  glycogen,  increased  acid  excretion  in  the  urine, 
certain  histologic  and  chemical  changes,  and  exhaustion. 

The  phenomena  of  the  kinetic  drive  in  animals  and  in 
man  are,  therefore,  essentially  the  phenomena  of  the  kinetic 
drive  of  a  locomotive.  The  locomotive  consumes  carbon 
in  the  form  of  coal;  man  consumes  carbon  in  the  form  of  gly- 
cogen. The  locomotive  produces  heat  and  motion;  man 
produces  heat  and  motion.  The  locomotive  produces 
gaseous  and  solid  acid  by-products — so  does  man.  If  the 
exchange  of  gases  in  the  firebox  of  a  locomotive  is  stopped, 
energy  transformation  ceases,  the  locomotive  dies;  if  the 
exchange  of  gases  in  man  is  suspended,  man  ceases  to  trans- 
form energy — man  dies. 

Never  before  has  there  been  such  an  opportunity  for 
studying  the  behavior  of  the  human  mechanism  under  the 
strongest  physical  and  psychic  stress  as  in  warring  Europe 
today.  There  observations  of  the  injured,  of  soldiers  in 
the  field,  of  prisoners  and  of  refugees  gave  me  an  oppor- 
tunity for  studying  the  human  kinetic  drive  on  a  vast  field. 
The  photomicrographs  show  the  effect  upon  the  brain,  the 
adrenals,  and  the  liver  of  some  of  the  kinetic  stimuli  to 
which  these  men  had  been  subjected  (Fig.  n). 

IV.    CONTROL  OF  THE  KINETIC  DRIVE 

Turning  from  the  phenomena  of  the  kinetic  drive  to 
methods  of  control,  we  find  first  that  morphin  controls  the 
rate  of  energy  transformation  in  response  to  any  stimulus. 


36  THE    KINETIC    DRIVE 

Whatever  the  activation,  whether  infection,  emotion,  injury, 
or  Graves'  disease,  morphin  measurably  controls  the  outward 
phenomena,  such  as  the  pulse-rate,  respiratory  exchange, 
sweating,  thirst,  restlessness,  acid  excretion,  fever,  muscular 
action,  and  pain. 

The  value  of  opium  in  infections  and  in  pain  is  one  of  the 
foundation  stones  of  medicine.  And  here  I  must  pause  for  a 
moment  to  pay  tribute  to  a  talented  New  York  physician, 
Alonzo  Clark,  who  on  empyric  grounds  made  a  daring  inno- 
vation in  the  opium  treatment  of  peritonitis. 

Even  today  we  must  concede  that  next  to  surgical 
treatment  the  administration  of  opium  is  the  most  efficient 
treatment  for  peritonitis.  Guided  by  researches  made  in 
my  laboratory,  in  collaboration  with  my  associates,  I  have 
combined  the  administration  of  opium  with  surgical  treat- 
ment in  those  cases  of  peritonitis  only  in  which  the  kinetic 
drive  threatens  to  kill  the  victim.  In  such  cases  a  quick 
anociated  operation  under  nitrous  oxid,  Fowler's  position, 
huge  hot  packs,  saline  infusions,  sodium  bicarbonate,  and 
glucose  plus  the  Alonzo  Clark  opium  treatment  for  from 
twenty-four  to  forty-eight  hours  has  given  startlingly  good 
results.  Opium  blocks  the  kinetic  drive;  draining  relieves 
tension;  water  and  alkalies  control  acidosis,  and  the  patient 
gets  well.  Death  from  acute  peritonitis  from  any  cause  has 
almost  disappeared  from  the  Lakeside  Clinic.  The  amount 
of  opium  must  be  determined  not  by  quantity,  but  by  its 
effect  on  the  drive — the  respirations  should  be  reduced  to 
from  12  to  15  per  minute.  In  severe  cases  there  must  be  no 
therapeutic  faint-heartedness. 

The  final  test  of  any  theory  in  medicine  is  in  the  crucible 
of  the  clinic.  Our  laboratory  findings  support  not  only  the 
kinetic  theory,  but  also  the  postulate  that  the  kinetic  drive 
may  be  largely  controlled  by  the  use  of  morphin,  nitrous  oxid, 


CONTROL    OF    THE    KINETIC    DRIVE 


37 


ed   See. 


Added  5~CC  Blood  T 


Hdrenalin 


FIG.  12. — TRACING  ILLUSTRATING  PROTECTIVE  EFFECT  OF  MORPHIN  IN  ANAPHY- 

(  LACTIC  SHOCK. 

In  A  the  adrenin  which  appears  in  the  blood  as  a  result  of  anaphylaxis  inhibits 
the  contractions  of  the  intestinal  muscle.  Tracing  B  shows  that  the  injection  into 
a  morphinized  animal  of  beef-serum,  which  in  the  normal  animal  would  have  caused 
a  strong  anaphylactic  reaction  and  a  greatly  increased  output  of  adrenin,  causes  no 
increased  output  of  adrenin  as  is  evidenced  by  the  contractions  of  intestinal  muscle, 
as  in  normal  blood.  Since  morphin  acts  directly  upon  the  brain,  this  experiment 
evidences  not  only  the  protective  effect  of  morphin,  but  also  the  dependence  of  the 
adrenal  upon  the  brain  for  its  activity. 

and  alkalies.  In  the  laboratory  we  have  found  that  morphin 
prevents  the  mobilization  of  adrenin  (Fig.  12);  that  mor- 
phin and  nitrous  oxid  block  energy  transformation  and  pre- 


38  THE    KINETIC   DRIVE 


FIG.  13. — PROTECTIVE  EFFECT  OF  MORPHIN  AND  OF  NITROUS  OXID  ON  THE  BRAIN- 
CELLS  OF  DOGS  WHICH  HAD  RECEIVED  INJECTIONS  OF  DIPHTHERIA  TOXIN.  (From 
photomicrographs  X  310.) 

Compare  the  Purkinje  cells  in  C  and  D  with  the  disintegrated  hypochromatic  cells 

in  B. 
A  B 

Section  of  normal  cerebellum  of  a  dog.  Section  of  cerebellum  of  a  dog  after  injection 

of  diphtheria  toxin. 

C  D 

Section  of  cerebellum  of  a  dog  after  injection  Section  of  cerebellum  of  a  dog  after  injec- 

of  diphtheria  toxin  plus  morphin.  tion  of  diphtheria  toxin  and  the  continuous 

administration  of  nitrous  oxid  for  four  hours. 


FIG.  13. 


3Q 


40  THE    KINETIC   DRIVE 


FIG.  14. — PROTECTIVE  EFFECT  OF  MORPHIN  AND  OF  NITROUS  OXTD  ON  THE  AD- 
RENALS OF  DOGS  WHICH  HAD  RECEIVED  INJECTIONS  OF  DIPHTHERIA  TOXIN. 
(From  photomicrographs  X  1640.) 

Note  the  general  disappearance  of  cytoplasm  and  nuclei  in  B  and  compare  with  the 
normal  appearance  of  C  and  the  conserved  nuclei  in  D. 

A  B 

Section  of  normal  adrenal  of  dog.  Section  of  adrenal  of  a  dog  after  injection  of 

diphtheria  toxin. 

C  D 

Section  01  adrenal  of  a  dog  after  injection  of  Section  of  adrenal  of  a  dog  after  injection  of 

diphtheria  toxin  plus  morphin.  diphtheria  toxin  and  the  continuous  admin- 

istration of  nitrous  oxid  for  four  hours. 


FIG.  14. 


42  THE    KINETIC   DRIVE 


FIG.  15. — PROTECTIVE  EFFECT  OF  MORPHIN  AND  OF  NITROUS  OXID  ON  THE  LIVERS 
OF  DOGS  WHICH  HAD  RECEIVED  INJECTIONS  OF  DIPHTHERIA  TOXIN.  (From 
photomicrographs  X  1640.) 

Note  the  vacuolation  of  B  and  compare  with  the  conservation  of  nuclei  and  cyto- 
plasm in  C  and  D. 
A  B 

Section  of  normal  liver  of  a  dog.  Section  of  liver  of  a  dog  after  injection  of 

diphtheria  toxin. 

C  D 

Section  of  liver  of  a  dog  after  injection  of  Section  of  liver  of  a  dog  after  injection  of 

diphtheria  toxin  plus  morphin.  diphtheria  toxin  and  the  continuous  admin- 

istration of  nitrous  oxid  for  four  hours. 


FIG.  15. 


43 


CONTROL   OF   THE   KINETIC   DRIVE 


45 


(fl      rt       r, 
jj     G       r\ 

8-S    g 


II 


<  X 

5t 


2>M 
l-s 

11 

S    o 
<u  -3 

u^ 

.S    u 

W)    o 


S|  s-S 

^  c.   u    S 

illl 
II  §1 

o    w  o 

u    cj      Cfl      JH 

<4H     M-l         t~*      [r, 

^    ft     r  i   ." . 


^ 

S  § 

M 

< 


O 

O 


M 


.2   £? 

O    ^t/) 

en   'H 

<U     OJ 

a  5 
«  S 
.3  -g 

^2    S3 

"3  2* 
u  S 

.2,8 
.S  * 

^4     oj 

a  % 


CJ 


CONTROL    OF    THE    KINETIC    DRIVE 


47 


s  £ 
3  j 

'S  u 
B  J 

<->  J!"s 

cs    3 
c  -3 


-a 
i 


8  r; 

o  U 


1 

.§"  « 

II 
a    g 

s| 

«•»  I 

•3  ^ 


X 


o     u 

II 

u  g< 
D  — 
<u  os 

^  13 

73     | 

g    o 

rt     G 


^  a 

5  3 

<    o 

g-a 

BM 


CONTROL   OF    THE   KINETIC   DRIVE 


49 


3      •     H 


II 


_   fc         a 

.20  M 

*^     w  T3 

M  O 

<«  -t-> 

H 

H!   ^-s     O 

<!    d     3 

S4.8 

^     S/       rt 

a,     O    X    ^ 


o 


«^s      TO 

PH   u    g 
"o  ^ 


^  8 

^  ^ 

&  O 

0  -s 

tn  O< 


a   a 
a  .o 


t 


1/3       W 


ill! 


k-«2flB»<'£ 


< 


CONTROL    OF    THE    KINETIC   DRIVE 


v^S&**"  *»  .  ^  » •'.  «- 

JP»^  4^  -  '  ,<» 

*/<>  *JT  t&*^    ^  . '  . 

^^*»  «**/^'»V  *       Ca^1  ?         •    *3Ct/  <  • 

K  -frf^Si^x^'t*^*-**  ;  ' 

.    •  *  * ^5/*'  '€'  y<  £?*>»*'£  > 

•  A  ^      *  *    *P «.»  *     Tr    *CL*        «P|    <*--  - 


s 
y 
< 

BB 

> 

"15 

8 

| 

2 

- 

^ 

d 

M 

e 

•g 

| 

< 

2 
^ 

to 
X 

r: 

-C 
^ 

^ 

O 

m 

_0 

•  —  ' 

!? 

f 

'"I 

3 

< 

y. 

89 

6 

_c 

& 

4) 

o 

aj 

> 

~ 

€ 

O 

V 

M 

5 

<• 

a 

u 

£ 

| 

as 

> 

H 

'E 

*3 

ij 

g 

^ 

jj 

< 
u 

m 
O 

£ 

^ 

o 
o 

-f 

x 
P 

*s 

IS 
* 

CA 

q 

g 

h 

M 

.—  . 

tc 

O 

w 

1 

•o 

rt 

O 

P 

Cfl 

«" 

"3 

Ci. 
_t. 

H 

¥ 

E 

W 

I 

— 

^ 

pa 

22 

ce 

-rj 

1 

Q 

—^ 

H 

2 

"3 

"S 

fc 

HH 

E 

r 

" 

M 

-^ 

§ 

- 

— 

•—i 

i 

0 

"o 

O 

~6 

i 

U 

C 

E 

^ 

OMPARISON  B 

DOG  WHOSE 

i  of  normal  ce 

s 
i 

1 
d 

1 

O 

c 

r- 

-3 

tf&J 

3   a 

tn     tn 


CONTROL   OF    THE   KINETIC   DRIVE  53 

vent  the  histologic  changes  wrought  by  physical  injury,  in- 
fection, and  emotion  (Figs.  13-15),  and  that  alkalies  counter- 
act the  effect  of  a  kinetic  drive  by  supplying  the  rapidly 
increasing  deficiency  of  neutralizing  bases  (Figs.  16-18). 
These  laboratory  findings  have  been  tested  in  Lakeside 
Hospital  in  a  long  series  of  operations  on  the  stomach  and 
the  intestines,  on  the  biliary  tract,  the  pelvic  organs,  and  the 
appendix;  in  clean  cases  and  in  cases  complicated  by  the 
severest  acute  infections,  with  a  resultant  remarkable  reduc- 
tion in  both  morbidity  and  mortality. 

The  excessive  energy  transformation  caused  by  physical 
injuries,  such  as  blows,  crushes,  penetrations,  surgical  opera- 
tions, etc.,  like  that  caused  by  infection,  may  be  blocked 
by  morphin  and  nitrous  oxid  and  the  effect  minimized  by 
alkalies  and  water,  and,  as  in  the  infections,  the  dosage  should 
be  proportional  to  the  intensity  of  the  activation.  In  sur- 
gical operations  the  brain  may  be  insulated,  and  in  conse- 
quence its  driving  power  prevented  by  local  anesthesia  of  the 
surgical  field,  or  by  blocking  the  spinal  cord  or  the  nerve- 
trunks  communicating  with  the  field  (Fig.  19).  While  it 
is  safe  to  block  the  kinetic  drive  by  morphin  in  cases  of  acute 
injury  or  of  acute  infection,  it  is  unsafe  to  use  opium  to  block 
the  effects  of  intense,  emotion  because  of  the  danger  of  habit 
formation.  TKe  tendency  to  habit  formation,  however,  is 
the  strongest  possible  evidence  of  the  power  of  morphin  to 
control  the  kinetic  drive.  The  emotional  drive  with  its  con- 
sequences, identical  with  the  consequences  of  infection? 
exertion,  or  physical  injury,  is  best  met  through  training  and 
education  leading  to  a  philosophy  of  life  that  insulates  the 
individual  against  destructive  psychic  stimuli.  Thus  may 
the  individual  be  anociated  in  the  large  clinic  of  life,  just  as 
through  local  anesthesia  the  patient  is  anociated  against  the 
drive  of  the  surgeon's  knife. 


54  THE   KINETIC  DRIVE 

V.    THE  CHRONIC  KINETIC  DRIVE 

Turning  now  from  the  individual  acutely  driven  by  injury, 
by  infection,  by  emotion,  let  us  consider  the  individual 
chronically  driven  by  the  stimuli  of  want,  ambition,  anger, 
jealousy,  or  grief;  by  infection,  by  pain,  by  auto-intoxication. 
In  the  acute  kinetic  drive  the  individual  is  endangered  by 
death  from  exhaustion  or  from  acid  intoxication;  whereas 
in  the  chronic  drive  the  danger  is  that  one  or  another  of  the 
overdriven  organs  or  tissues  may  be  permanently  injured. 
In  an  acute  drive  simple  and  direct  control  is  possible;  in  a 
chronic  drive  we  may  encounter  the  added  difficulties  of 
pathologic  changes  in  one  or  more  organs  or  tissues.  We 
shall,  therefore,  discuss  separately  methods  of  control  for 
those  cases  of  chronic  drive  in  which  no  organic  change 
exists  and  for  those  in  which  organic  changes  do  exist. 

The  common  chronic  drives  are  mental  and  muscular 
overwork,  chronic  infections,  excessive  diet,  pregnancy; 
the  emotions  of  fear,  hate,  jealousy,  shame,  despair;  and 
foreign  proteins,  as  in  intestinal  stasis.  These  conditions 
present  every-day  problems  and  demand  but  little  dis- 
cussion. Since  the  lesions  of  these  various  driving  causes 
are  the  same ;  since  infection,  emotion,  and  overwork  produce 
identical  end-effects;  since  usually  two  or  three  of  these 
operate  simultaneously,  and  since  the  emotional  states  are 
most  amenable  to  control,  it  becomes  obvious  why  these 
conditions  have  often  been  controlled  by  means  which  have 
apparently  no  direct  therapeutic  value,  such  as  faith  in  the 
physician,  travel,  diversion,  prayer,  healing  springs,  phil- 
osophy, Christian  Science.  Again  and  again,  in  the  domain 
of  regular  medicine  as  in  the  domain  of  irregular  medicine, 
the  exclusion  of  worry  has  relieved  the  drive  sufficiently  to 
allow  the  body  processes  to  overcome  the  primary  disease. 
But  the  reverse  is  true  also.  Innumerable  men,  under  the 


KINETIC   DISEASES  55 

strain  of  a  chronic  drive,  are  pushed  beyond  the  narrow  limits 
of  safety  by  the  added  drive  of  grief,  worry,  or  shame.  Is  it 
not  possible  that  when  it  is  understood  that  the  various 
kinetic  stimuli  have  interchangeable  physical  values,  the 
game  of  health  will  be  more  skilfully  played?  Incidentally, 
the  chronic  drive  presumes  a  mild  chronic  acidosis  at  least. 
This,  as  Lawrence  Henderson  suggests,  might  be  in  part 
counteracted  by  alkalies  and  water. 

VI.    KINETIC  DISEASES 

Passing  now  to  that  group  of  individuals  whose  organs 
have  become  effected  by  excessive  energy  transformation, 
we  meet  with  our  greatest  difficulties.  The  proper  prosecu- 
tion of  this  theme  would  mean  an  extensive  work  on  medicine. 
I  shall,  therefore,  give  but  a  few  illustrations. 

Graves'  Disease. — First  of  all,  perhaps  the  most  typical 
of  the  kinetic  diseases  is  Graves'  disease.  In  Graves'  disease 
the  kinetic  system  is  driven  by  a  continuous  activation,  be- 
cause in  this  disease  there  has  been  established  a  pathologic 
interaction  between  the  brain  and  the  thyroid,  whereby  the 
threshold  to  all  stimuli  is  kept  continuously  low.  Graves' 
disease  exhibits  a  progressive  alteration  in  every  function  of 
the  body,  leading  eventually  to  exhaustion,  with  visible 
lesions,  depending  upon  the  duration  and  severity  of  the 
disease,  in  every  organ  and  tissue  of  the  body;  not  alone  in 
the  brain,  adrenals,  and  liver,  but  in  the  heart  and  blood- 
vessels, the  muscles,  the  thyroid,  the  thymus,  the  pancreas, 
the  spleen,  the  lymphatics,  the  skin,  the  skeletal  muscles, 
the  teeth,  the  hair,  and  the  bony  skeleton.  Extreme  and 
protracted  exhaustion  from  excessive  exertion,  excessive 
emotion,  or  chronic  infection  causes  similar  lesions. 

In  other  words,  the  principal  phenomena  of  Graves' 
disease  are  identical  with  the  leading  phenomena  of  any  other 


56  THE   KINETIC   DRIVE 

kinetic  drive  of  a  corresponding  degree  of  intensity,  and  may 
be  duplicated  by  fear,  anger,  sexual  excitation,  physical 
exertion,  overwork,  or  acute  infection.  Conversely,  many 
of  these  activations  cause  hyperplasia  of  the  thyroid.  Thus 
fear,  anger,  or  sexual  emotion  may  cause  temporary  enlarge- 
ment of  the  thyroid;  there  is  hyperplasia  in  pregnancy,  in 
chronic  infections,  and  perhaps  in  intestinal  auto-intoxication 
as  well. 

There  is  a  fundamental  resemblance  between  certain 
aspects  of  Graves'  disease,  of  iodism,  of  adreninemia,  of 
emotion,  and  of  infection.  The  resemblance  so  often  noted 
between  Graves'  disease  and  excessive  emotion  is  not  sur- 
prising in  view  of  the  frequency  with  which  the  disease  is 
traced  to  an  emotional  origin,  for  among  the  stimuli  initiating 
Graves'  disease  protracted  emotion  is,  perhaps,  the  most 
dominant.  In  a  majority  of  cases  careful  inquiry  will  dis- 
close some  deeply  entrenched  disturbing  emotional  factor — 
a  great  grief,  the  existence  of  harassing  home  conditions, 
poverty  or  shame,  business  reverses,  overwhelming  responsi- 
bilities, an  unhappy  love  affair  or  some  acutely  distressing 
thought,  which  drives  the  kinetic  system  incessantly.  In 
my  own  experience,  in  cases  of  Graves'  disease  for  the  causa- 
tion of  which  no  factor  in  the  external  environment  can  be 
held  responsible,  the  internal  environment  has  usually  sup- 
plied the  disturbing  factor — infection  or  auto-intoxication, 
for  example.  I  have  never  known  a  case  of  Graves'  disease 
to  result  from  hard  physical  labor,  unattended  by  "psychic" 
strain,  nor  from  energy  voluntarily  and  naturally  expended. 

Whatever  the  exciting  cause  of  Graves'  disease,  however, 
whether  unusual  business  worry,  disappointment  in  love, 
a  tragedy,  a  strong  fear,  the  illness  of  a  loved  one,  intestinal 
auto-intoxication,  an  acute  or  chronic  infection,  or  the  ad- 
ministration of  excessive  doses  of  iodin  or  thyroid  extract, 


KINETIC   DISEASES 


57 


the  symptoms  are  identical,  and  closely  resemble  the  phe- 
nomena of  one  of  the  great  primitive  emotions,  of  infection 
or  of  extreme  exertion  (Fig.  20). 

There  is  a  period  of  excessive  kinetic  drive  in  fever  which 
exactly  corresponds  to  the  kinetic  drive  in  emotion,  and 


A  B 

FIG.  20. — SIMILARITY  BETWEEN  THE  FACIES  OF  ACUTE  AND  OF  CHRONIC  EMO- 
TIONAL ACTIVATION. 

A,  Chronic  emotional  activation  (photograph  of  a  typical  case  of  exophthalmic 
goiter);  B,  acute  emotional  activation  (photograph  of  a  soldier). 

which  signifies  the  preparation  of  the  organism  for  self-de- 
fense by  chemical  activity,  just  as  emotion  signifies  the  prep- 
aration of  the  organism  for  self-defense  by  motor  activity. 
The  evolution  of  a  receptor  mechanism  for  foreign  proteins 
may  be  explained  on  the  ground  that  only  by  oxidation  is  the 
body  able  to  split  up  and  eliminate  foreign  proteins.  The 


58  THE    KINETIC    DRIVE 

one  method  of  inducing  oxidation  is  through  the  kinetic  sys- 
tem. The  living  protein  molecules  of  the  body  are  more 
resistant  than  the  foreign  protein  molecules,  hence  the  body 
is  purified  by  fire — by  oxidation. 

It  would  seem,  therefore,  that  fever  is  the  result  of  a  ^ 
driving  of  the  kinetic  mechanism  by  an  infection  (foreign 
protein)  stimulus  for  purposes  of  self-defense  by  the  splitting 
up  of  the  molecules  of  the  foreign  protein  through  the  trans-  f 
formation  of  latent  energy  into  heat;  and  it  would  seem  that 
emotion  is  the  result  of  a  driving  of  the  same  mechanism  by  a 
psychic  stimulus  for  purposes  of  self-defense  or  procreation, 
in  part,  at  least,  by  muscular  action;  while  Graves'  disease 
is  a  purposeless  driving  of  the  mechanism  by  some  obscure 
\  I  disarrangement  connected  with  a  pathologic  alteration  in  the 
function  of  the  thyroid. 

Reasoning  from  the  secure  facts  of  the  clinic  and  the  less 
secure  data  of  the  laboratory,  I  conclude  that  the  primary 
lesion  of  exophthalmic  goiter  is  the  establishment  of  an 
abnormal  facility  for  the  passage  of  action  currents  in  the 
central  nervous  system.  As  previously  stated,  Osterhaut  has  / 
given  us  definite  data  as  to  the  effect  of  iodin  on  the  electric 
permeability  of  kelp.  There  is  evidence  on  a  vast  scale 
that  such  a  state  of  increased  electric  permeability  exists 
in  exophthalmic  goiter.  It  has  been  stated  that  electric 
currents  are  increased  in  the  skin  of  patients  with  exophthal-  V 
mic  goiter.  Exophthalmic  patients  are  extremely  sensitive 
to  all  stimuli,  infection,  auto-intoxication,  injury,  emotion, 
electricity. 

That  these  several  activations  involve  the  same  mechan- 
ism is  borne  out  by  many  points  of  similarity  between  Graves' 
disease  and  infections  (Fig.  22).  The  likeness  of  the  phe- 
nomena of  the  kinetic  drive  in  Graves'  disease  to  those  of 
chronic  infections,  particularly  of  tuberculosis,  is  so  marked 


FIG.  21. — EFFECTS  OF  VARIOUS  FORMS  OF  CHRONIC  ACTIVATION  ON  THE  BRAIN- 
CELLS.     (From  photomicrographs  X  310.) 

A,  Section  of  normal  human  cerebellum  (after  accidental  death);  B,  section  of 
human  cerebellum  after  death  from  acute  acidosis;  C,  section  of  human  cerebellum 
after  death  from  exophthalmic  goiter;  D,  section  of  human  cerebellum  after  death 
from  acute  septicemia;  E,  section  of  human  cerebellum  after  death  from  eclampsia; 
F,  section  of  human  cerebellum  after  death  from  cardiovascular  disease.  The 
arrows  mark  the  site  of  the  almost  completely  disintegrated  Purkinje  cells. 

SQ 


KINETIC   DISEASES  6 1 

that  it  is  not  at  all  uncommon  to  find  diagnosticians  of  wide 
experience  recommending  treatment  for  tuberculosis  to  a 
patient  with  Graves'  disease,  and  an  operation  for  Graves' 
disease  to  a  patient  with  tuberculosis.  In  two  different 
cases  of  the  same  degree  of  intensity  it  may  be  almost  im- 
possible to  distinguish  the  case  of  Graves'  disease  from  the 
case  of  tuberculosis.  Sometimes  both  conditions  may  be 
present  in  the  same  patient.  The  following  symptoms  are 
common  to  both  Graves'  disease  and  tuberculosis — tachy- 
cardia, increased  respiration,  flushed  face,  tremors,  persistent 
slight  fever,  nervousness,  rapid  loss  of  weight,  digestive 
disturbances,  increased  acidity  of  the  urine,  hyperplasia 
of  the  thyroid  and  of  the  lymph-glands,  and  enlargement  of 
the  heart.  Even  at  autopsy  the  lesions — barring  the  tuber- 
culosis focus  itself — may  be  so  nearly  identical  in  the  two 
cases  as  to  baffle  differentiation.  In  tuberculosis  as  in 
Graves'  disease  the  entire  kinetic  system  is  overdriven. 

Thus,  the  kinetic  theory  of  Graves'  disease,  of  infections, 
and  of  emotion  supplies  a  possible  biologic  interpretation  of 
the  induction  of  these  states,  of  their  mutual  resemblance, 
and  of  the  method  of  their  control.  All  are  modified  by  rest; 
•all  are  temporarily  controllable  by  morphin;  all  cause  in-  y^ 
creased  H-ior^  concentration  in  the  blood;  and  therefore 
tax  heavily  the  organs  of  acid  neutralization,  namely,  the 
respiratory  center,  the  kidneys,  the  adrenals,  and  the  liver. 
The  increased  respiratory  rate  in  each  of  these  conditions  is  \^ 
accounted  for  by  the  specific  stimulative  effect  of  the  increased 
H-ion  concentration  of  the  blood  on  the  respiratory  center. 
The  demand  for  neutralization  of  the  increased  acidity  inci-  > 
dent  to  emotion,  work,  infection,  or  Graves'  disease  is  re- 
sponded to  by  increased  activity  of  the  liver.  If  the  acidity 
is  increased  so  rapidly  that  neutralization  cannot  keep  pace 
with  it,  then  nephritis  may  develop  as  an  effect  of  the  acid 


62  THE   KINETIC   DRIVE 

by-products  upon  the  kidneys.  Hence,  in  intense  emotion, 
exertion,  infections,  and  Graves'  disease,  albumin  and  casts 
are  frequently  and  sugar  sometimes  found  in  the  urine,  and 
in  extreme  cases  acute  acidosis  may  develop.  The  acidosis 
of  emotion,  of  infection,  and  of  Graves'  disease  is  expressed 
in  each  case  by  thirst.  The  cycles  of  vomiting  in  Graves' 
disease  are  probably  caused  by  acidosis,  which  is  the  most 
common  cause  of  death  in  this  disease.  Thus,  in  the  im- 
mediate symptoms  and  in  the  end-effects,  even  to  the  result- 
ing acidosis  and  pathologic  lesions,  we  find  a  close  resemblance 
in  the  essential  phenomena  of  exertion,  emotion,  infection, 
and  Graves'  disease — phenomena  which  are  harmonized  and 
interpreted  by  the  kinetic  theory. 

Cardiovascular  Disease. — The  analogy  between  diseases 
of  the  thyroid  and  diseases  which  among  other  organs 
involve  the  adrenals  is  borne  out  by  many  clinical  points. 
Graves'  disease  and  cardiovascular  disease  have  many  points 
in  common.  Each  of  these  conditions  bears  an  intimate 
relation  to  foreign  protein  activation  and  to  "nervous  strain." 
The  etiology  of  Graves'  disease  is  much  the  same  as  that  of 
cardiovascular  disease.  In  each  of  these  diseases  a  recall  of 
the  unhappy  circumstances  or  conditions  which  led  to  or  pre- 
cipitated the  acute  stage  is  sufficient  to  cause  an  exacerbation 
of  all  its  symptoms.  The  most  efficient  means  by  which 
each  of  these  diseases  may  be  modified  are  rest,  diversion, 
change  of  scene,  and  occupation.  In  each  the  secretion  of  the 
gland  most  involved  seems  to  bear  a  specific  relation  to  the 
production  of  the  disease.  For  instance,  as  has  been  stated , 
the  cardinal  symptoms  of  Graves'  disease  may  be  produced  in 
a  normal  person  by  the  administration  of  sufficient  thyroid 
extract,  and  in  the  patient  with  Graves'  disease  the  adminis- 
tration of  thyroid  extract,  even  in  small  quantities,  causes  an 
immediate  exacerbation  of  the  symptoms.  In  like  manner, 


KINETIC   DISEASES  63 

adrenin  aggravates  the  symptoms  of  cardiovascular  disease, 
and  when  given  to  a  normal  animal  in  excessive  dosage  is 
said  to  produce  lesions  similar  to  arteriosclerosis.  Like  re- 
sults cannot  be  obtained  by  the  administration  of  the  secre- 
tion of  any  other  gland  in  the  body.  In  Graves'  disease  the 
thyroid  is  always  enlarged;  in  cardiovascular  disease  the 
adrenals  are  usually  enlarged. 

The  literature  of  the  etiology  of  arteriosclerosis  is  a  long 
record  of  superlative  stimulations  and  deep  depressions;  a 
story  of  great  risks  taken  and  great  losses  borne;  of  heavy 
burdens  carried  and  long  strains  endured;  of  vast  responsi- 
bilities assumed;  of  excessive  dissipation;  of  chronic  infec- 
tion; of  auto-intoxication;  of  overindulgence  in  food  and  in- 
toxicants; of  great  joys  and  great  griefs;  of  hopes,  anxieties, 
and  despair.  It  is  essentially  a  story  of  the  modern  world; 
of  power  and  progress  and  success;  of  liberty  and  luxury 
and  of  their  antitheses;  of  mental  tolerance  combined 
with  bitter,  crushing  oppression.  The  contemplative  scholar 
of  the  Middle  Ages,  the  bucolic  Swede,  the  wandering 
Scotch  bard,  the  Italian  peasant,  these  probably  did  not  know 
arteriosclerosis  except  as  the  logical  accompaniment  of  a 
ripe  old  age.  The  director  of  vast  financial  enterprises,  the 
man  who  holds  the  fates  of  thousands  in  his  hand,  he  who 
carries  tremendous  physical  burdens;  the  Chinese  coolie,  the 
Japanese  rickshaw  man,  the  athlete  of  the  western  world, 
the  emotional  American,  the  excitable  Jew,  the  bank  presi- 
,dent,  the  bon  vivant,  these  are  the  men  whose  days  are  short- 
ened by  early  hardening  of  the  arteries,  who  preempt  to 
themselves  the  cardiovascular  and  likewise  the  cardiorenal 
diseases.  The  superlatively  emotional  Jew,  besides  being  a 
frequent  victim  of  cardiovascular  disease,  is  likewise  a  fre- 
quent sufferer  from  the  allied  condition,  endarteritis  obliter- 
ans.  Among  animals  the  high-spirited  wild  animals  in  cap- 


64  THE    KINETIC    DRIVE 

tivity,  the  mettled  race  horse,  and  the  dray  horse,  fretted  and 
driven  often  beyond  its  capacity,  are  frequent  sufferers  from 
cardiovascular  disease.  The  somnolent,  unfettered  cow  is 
exempt. 

Bright's  Disease. — In  the  great  strain  laid  upon  the 
organs  of  reduction  and  elimination  by  the  excessive  causa- 
tion of  acid  by-products  as  a  result  of  the  kinetic  drive  of 
emotional  activation,  physical  exertion,  and  infection  we 
may  find  common  causes  of  Bright's  disease.  We  have 
shown  by  experiment  that  in  frightened  rabbits,  enraged  cats, 
and  traumatized  dogs  the  kinetic  system  can  be  driven  at 
such  a  rate  of  speed  that  the  organism  is  unequal  to  the  task 
of  neutralizing  the  too-rapidly  formed  acid  by-products  so 
that  they  can  be  eliminated  without  injury  to  the  kidneys. 
In  addition,  we  have  shown  that  when  the  activity  of  the 
brain  has  been  depressed  by  morphin  the  rate  of  transforma- 
tion of  energy  is  decreased  and  the  production  of  acid  by- 
products correspondingly  lessened.  If,  as  seems  probable, 
the  adrenals  and  the  liver  are  the  most  important  agents  by 
which  the  reduction  of  the  acid  by-products  is  accomplished, 
then  an  habitual  failure  of  these  organs  to  perform  this  func- 
tion might  lead  to  an  accumulation  of  harmful  compounds 
which  would  directly  facilitate  tissue  degeneration  in  the 
kidneys,  thus  causing  nephritis.  In  Bright's  disease  hyper- 
plasia  of  the  adrenals  is  frequently  seen. 

Diabetes. — The  more  powerful  excitants  of  the  kinetic 
system  cause  an  increased  output  of  adrenin,  and  adrenin 
causes  the  mobilization  of  the  glycogen  stored  in  the  liver, 
so  that,  among  other  results  of  kinetic  activation,  glycosuria 
is  produced.  While  glycosuria  is  not  diabetes,  it  represents 
a  step  toward  this  disease,  and  one  would  expect,  therefore, 
that  the  kinetic  drive,  which  in  one  individual  causes  the 
breakdown  of  the  thyroid,  in  another  of  the  brain,  and  in 


SURGICAL   METHODS    OF   CONTROLLING   KINETIC   DRIVE      65 

another  of  the  adrenals,  in  others  might  produce  diabetes. 
That  this  is  so  is  shown  by  the  fact  that  diabetes  is  improved 
by  the  conditions  which  obviate  psychic  strain.  The  identi- 
fication of  the  common  causes  of  diabetes  with  the  common 
causes  of  Graves'  disease,  arteriosclerosis,  neurasthenia,  and 
Bright's  disease  may  explain  why,  in  the  words  of  a  certain 
phrase  maker,  "when  stocks  go  down  in  New  York,  diabetes 
goes  up";  why  diabetes  is  more  commonly  found  in  large 
cities,  among  individuals  and  races  who  are  constantly  under 
a  strain  of  business  perplexities,  and  are  constantly  within 
sight  and  hearing  of  thousands  of  irritating  and  harassing 
episodes;  and  why  it  is  rare  in  localities  where  leisurely  and 
quiet  ways  of  life  prevail.  In  the  fact  that  here,  again,  the 
emotional  trade-driven  Jew  is  a  frequent  sufferer  we  have 
important  matter  for  consideration. 

Diabetes  not  only  numbers  among  its  common  causes  the 
common  causes  of  other  kinetic  diseases,  but,  as  in  the  case 
of  Graves'  disease,  arteriosclerosis,  neurasthenia,  etc.,  it  is 
improved  by  rest,  diversion,  and  dietetic  control. 

VII.    SURGICAL  METHODS  OF  CONTROLLING  THE  KINETIC 

DRIVE 

It  would  seem  to  follow  that  a  chronic  disease  which  is 
made  worse  byincreasing  the  kinetic  drive  would  be  improved 
by  lessening  the  drive,  and,  in  like  manner,  would  be  improved 
temporarily  by  blocking  the  drive  by  means  of  morphin. 
Morphin  is  but  a  temporary  expedient,  however,  and  the 
results  of  its  use  may  be  worse  than  the  disease  caused  by  the 
drive.  If  the  effects  of  morphin  are  produced  by  its  control 
of  the  driving  force  of  the  brain,  thus  preventing  the  brain 
from  driving  the  adrenals  and  the  thyroid,  then  a  like  result 
to  that  produced  by  morphin  could  be  secured  by  breaking 
the  connection  between  the  brain  and  the  thyroid  and  the 

5 


66  THE    KINETIC    DRIVE 

adrenals;  by  the  excision  of  a  portion  of  the  thyroid  and  of 
the  adrenals;  and,  if  still  further  blocking  of  brain  impulses 
be  required,  by  dividing  the  cervical  sympathetics  as  well. 

One  would  not  expect  these  procedures  to  produce  any 
subjective  change  in  the  patient.  No  function  would  be  lost. 
He  could  work,  be  subject  to  emotion,  and  respond  to  in- 
fection as  before,  with  the  following  exceptions — his  power  of 
physical  exertion  would  be  diminished,  as  would  his  response 
to  emotional  stimuli  or  to  infection.  His  acid  excretion 
would  diminish  and  his  sugar  tolerance  would  increase. 
In  short,  those  diseases  that  are  temporarily  improved  by 
morphin  should  be  permanently  improved  by  this  process  of 
dekineticization. 

On  this  conception  I  have  ventured  on  new  surgical 
ground,  and  have  performed  fourteen  operations  on  patients 
with  chronic  diseases  resulting  from  an  excessive  kinetic 
drive.  I  first  operated  on  eleven  hopeless  epileptics,  then 
on  three  cases  of  Raynaud's  disease,  and  finally  on  an 
advanced  diabetic.  All  made  good  operative  recoveries. 
The  operation  performed  in  different  stages  comprised  the 
excision  of  one  adrenal,  the  excision  of  approximately  three- 
fourths  of  the  thyroid,  and  the  division  of  the  cervical 
sympathetic  trunks. 

It  is  now  two  and  a  half  years  since  the  first  of  these 
operations  was  performed.  It  was  not  expected  that  epi- 
lepsy would  be  cured,  but  that  the  force  of  the  attacks 
would  be  diminished  and  perhaps  the  intervals  lengthened, 
for,  since  the  epileptic  attack  represents  a  powerful  temporary 
kinetic  drive,  it  seemed  possible  that  the. severity  of  that 
drive  might  be  modified.  No  case  has  been  cured,  but  all 
made  good  operative  recoveries,  and  the  severity  of  the  at- 
tacks and  the  length  of  the  intervals  have  been  favorably 
influenced.  The  fact  that  some  of  these  cases  showed  an 


SURGICAL   METHODS    OF    CONTROLLING    KINETIC    DRIVE      67 

increased  sugar  tolerance  confirmed  us  in  our  belief  that 
the  same  procedure  might  be  of  avail  in  cases  of  diabetes. 
The  principal  net  result  of  these  operations  on  epileptic  pa- 
tients was  the  assurance  that  in  man  as  in  animals  these 
procedures  do  not  interfere  with  normal  functions.  This 
fact  being  established,  other  fields  are  now  being  approached 
cautiously. 

In  Raynaud's  disease  there  is  a  striking  diversion  of 
blood  to  the  extremities — in  ebbs  and  flows.  These  rhythms 
are  in  a  measure  determined  by  emotion,  by  cold,  etc.  Since 
it  is  known  that  Raynaud's  disease  is  most  common  in  that 
emotional  race,  the  Hebrew;  that  the  most  significant  effect 
of  emotion  is  the  increased  mobilization  of  adrenin,  and  that 
one  of  the  results  of  the  increased  fabrication  of  adrenin  is 
the  transference  of  blood  from  the  inner  organs  to  the  surface 
of  the  body,  it  would  seem  that  this  otherwise  hopeless  dis- 
ease might  with  propriety  be  attacked  on  a  kinetic  basis. 
The  three  cases  thus  surgically  treated  by  me — the  first  two 
and  a  half  years  ago — give  fair  promise  of  recovery.  But  in  a 
disease  of  such  chronicity,  the  different  phases  of  which  are 
manifested  in  such  long  rhythms,  judgment  must  be  reserved 
until  a  long  time  has  elapsed  and  until  many  cases  have  been 
observed. 

Since  the  kinetic  drive  may  be  concerned  in  greater  or  less 
degree  in  the  causation  or  continuance  of  Raynaud's  disease, 
Graves'  disease,  Bright's  disease,  and  diabetes,  on  a  priori 
grounds,  it  is  evident  that  either  none  or  all  of  these  will  t>e 
benefited  by  a  surgical  reduction  of  the  driving  power  of  the 
kinetic  system. 

We  have  already  compared  the  effects  of  the  kinetic  drive 
upon  the  normal  human  mechanism  to  the  normal  action  of 
a  locomotive.  In  like  manner  the  problem  presented  by 
these  kinetic  diseases  may  be  compared  to  the  effect  upon  a 


68  THE   KINETIC   DRIVE 

damaged  automobile  of  reckless  driving  by  an  irresponsible 
chaffeur.  In  such  a  case  the  machine  may  be  prematurely 
wrecked,  whereas,  with  careful  driving  at  a  moderate  speed, 
even  the  damaged  automobile  may  give  long  service.  Vast 
numbers  of  men  and  women  today  possess  such  damaged 
mechanisms  which  the  stress  of  present-day  life  is  driving  to 
inevitable  destruction.  Included  in  this  doomed  throng  are 
many  of  the  most  useful  men  and  women,  the  very  kinetic 
temperament  to  which  they  owe  their  achievements  proving 
to  be  also  their  greatest  menace.  It  is  for  such  cases  as  these, 
in  which  medicine  fails  to  provide  the  necessary  kinetic  con- 
trol, that  this  surgical  procedure  is  proposed.  In  considering 
this  operation  it  must  be  borne  in  mind  that  we  are  dealing 
with  poor  surgical  risks  and,  as  far  as  the  adrenalectomy  is 
concerned,  a  technically  difficult  operation.  Every  possible 
protection,  therefore,  should  be  provided.  It  is  most  impor- 
tant that  the  operation  be  performed  under  nitrous-oxid- 
oxygen,  rather  than  under  the  lipoid  solvent — ether.  The 
principle  of  anociation  should  be  applied  throughout  the 
operation,  as  the  excessive  acid  products  resulting  from  cut- 
ting or  handling  sensitive  tissues  may  diminish  too  much  the 
narrow  margin  of  safety  and  dispatch  the  patient.  Es- 
pecially is  this  true  of  diabetes. 

The  value  of  surgical  modification  of  the  kinetic  system  in 
that  intense  kinetic  drive — Graves'  disease — is  established. 
We  know  that  by  dividing  the  nerve-supply  of  the  thyroid, 
ligating  the  thyroid  arteries,  or  excising  a  portion  of  the 
thyroid  gland,  this  disease  is  modified  or  cured.  In  these 
cases  the  blood-pressure  falls,  the  myocarditis  improves, 
albumin  and  casts  disappear,  the  sugar  tolerance  is  raised, 
the  intense  neurasthenia  is  improved.  In  other  words,  the 
renal,  cardiovascular,  glycogenetic,  and  psychic  phenomena 
simultaneously  improve.  I  have  no  doubt  that  the  excision 


SURGICAL  METHODS    OF    CONTROLLING   KINETIC   DRIVE      69 

of  an  adrenal  or  the  division  of  the  nerve-supply  to  the 
adrenals  in  Graves'  disease  would  also  facilitate  the  cure. 

We  have  referred  to  the  lessening  of  glycosuria  by  opera- 
tion in  certain  cases  of  Graves'  disease.  It  is  well  known  that 
in  cases  of  either  adrenal  or  thyroid  deficiency  sugar  toler- 
ance is  raised,  while,  on  the  contrary,  the  injection  of  excess- 
ive amounts  of  adrenin  or  of  excessive  thyroid  extract 
mobilizes  sugar.  Therefore,  in  intractable  diabetes  may  it 
not  be  possible  that  the  diminution  of  the  total  mass  of  the 
adrenals  and  of  the  thyroid  may  sufficiently  increase  the 
sugar  tolerance  to  mitigate  or  actually  to  cure  the  disease? 
The  case  of  diabetes  which  I  have  so  treated,  through  the 
courtesy  of  Dr.  C.  F.  Hoover  and  Dr.  C.  D.  Christie  of 
Lakeside  Hospital,  is  a  male,  forty-two  years  of  age,  who 
was  admitted  to  Lakeside  Hospital  in  January,  1915.  For  a 
period  of  six  months,  until  June  25th,  when  the  first  opera- 
tion was  performed,  the  amount  of  sugar  in  his  urine  had 
ranged  daily  from  9.5  to  202.5  grams,  with  an  average  of 
96.4  grams.  At  no  time  during  these  six  months  until  the 
morning  of  the  first  operation  was  he  known  to  be  sugar 
free.  In  June,  at  intervals  of  three  and  seventeen  days 
respectively,  the  following  operations  were  performed:  (i) 
Section  of  the  right  cervical  sympathetic,  (2)  left  adrenal- 
ectomy,  and  (3)  excision  of  the  left  cervical  sympathetic 
with  partial  thyroidectomy.  The  patient  made  a  good  oper- 
ative recovery.  On  the  day  of  the  first  operation  the  sugar 
content  of  the  urine  was  83.6  grams;  on  the  following  day  it 
was  8.4  grams,  since  which  time,  with  the  exception  of  a  few 
instances  one  day  between  the  last  two  operations,  he  has 
been  continuously  sugar  free.  This  patient  now,  four 
months  after  his  first  operation,  is  taking  approximately 
250  grams  of  carbohydrates  daily,  and  since  his  operation 
he  has  gained  9  pounds.  It  should  be  stated  that  Dr. 


7<D  THE    KINETIC    DRIVE 

Christie  has  continued  a  careful  medical  supervision  of  the 
case,  employing  the  Allen  treatment.  Therefore,  to  obtain 
the  surgical  net  result  we  must  subtract  from  this  striking 
improvement  the  undetermined  factor  of  the  Allen  treat- 
ment. 

VHI.    SUMMARY 

The  kinetic  theory  harmonizes  many  facts  in  the  great 
clinic  of  life  as  well  as  hi  the  restricted  clinics  of  medicine;  it 
emphasizes  the  value  of  a  mechanistic  view  of  life  in  the 
study  of  both  normal  and  pathologic  processes;  and  it  sug- 
gests a  philosophy  of  life  by  means  of  which  self-preservation 
may  be  secured  through  kinetic  control. 

According  to  the  kinetic  theory,  the  resemblance  of 
many  normal  and  pathologic  processes — exertion,  emotion, 
infection,  auto-intoxication,  etc. — suggests  that  the  mechan- 
ism by  which  they  are  produced  is  identical  with  the  mechan- 
ism by  which  the  transformation  of  energy  and  the  elimina- 
tion of  acid  by-products  are  accomplished;  that  is,  that  these 
conditions  are  caused  by  variations  in  the  kinetic  drive. 

Since  an  excessive  kinetic  drive  may  be  the  result  of  the 
simultaneous  action  of  various  factors  in  the  external  and 
the  internal  environment,  then  the  control  of  one  or  more  of 
these  factors  will  lessen  the  drive  and  mitigate  its  effect. 
Thus  the  substitution  of  hope  for  fear  may  relieve  the  organ- 
ism of  one  driving  factor  and  by  so  much  relieve  the  strain 
upon  the  kinetic  system.  In  other  cases  the  depression  of 
the  activity  of  the  brain  by  morphin  or  by  nitrous  oxid  anes- 
thesia controls  an  acute  kinetic  drive. 

For  still  other  cases  in  which  disease  has  resulted  from 
the  physical  injury  wrought  in  certain  organs  by  an  excessive 
drive,  it  is  proposed  as  a  problem,  not  as  an  accomplished  fact, 
that  the  activating  organs  of  the  kinetic  system,  the  adrenals 
and  the  thyroid,  be  reduced  in  size  and  that  their  com- 


SUMMARY  71 

munication  with  the  driving  organ — the  brain — be  in  part 
severed.  By  an  analogous  method  the  result  of  an  intense 
kinetic  drive — Graves'  disease — is  modified  or  cured;  the 
accompanying  cardiovascular,  cardiorenal,  myocardial,  and 
neurasthenic  symptoms  are  coincidentally  relieved,  and  sugar 
tolerance  is  raised. 

If  Graves'  disease,  which  is  due  directly  to  the  overspeed- 
ing  of  the  kinetic  system,  is  thus  relieved  by  partial  excision 
of  one  of  the  driving  organs,  the  thyroid,  this  mechanistic 
treatment  effecting  simultaneously  the  cure  of  the  conditions 
brought  about  by  the  driving  power  of  Graves'  disease  itself^ 
then  the  logical  conclusion  is  that  these  allied  diseases  when 
brought  into  existence  by  other  kinetic  drives  may  be  miti- 
gated or  cured  by  a  dekineticizing  operation. 

This  is  suggested  as  an  unsolved  problem  suggested  by  a 
large  amount  of  experimental  data. 


UNIVERSITY  OF  CALIFORNIA 

Medical  Center  Library 

THIS  BOOK  IS  DUE  ON  THE  LAST  DATE  STAMPED  BELOW 

Books  not  returned  on  time  are  subject  to  a  fine  of  soc  per  volume  after 
the  third  day  overdue,  increasing  to  $1.00  per  volume  after  the  sixth  day. 
Books  not  in  demand  may  be  renewed  if  application  is  made  before  ex- 
piration of  loan  period. 


57n-7,'52(A2508s2)4128 


